Evaluation of retinopathy of prematurity screening in reverse Kangaroo Mother Care: a pilot study.

PURPOSE: To evaluate retinopathy of prematurity (ROP) screening practice in reverse Kangaroo Mother Care (R-KMC) with respect to stress and pain to the infant. METHODS: In a pilot study we evaluated ROP screening practice in R-KMC in 20 babies at risk of ROP. The R-KMC differed from the conventional KMC with respect to the baby position where the baby lay supine on mother's chest. With the mother lying supine and the baby in R-KMC position, screening examinations were done with indirect ophthalmoscope. The outcome measures included stress (quantified by pulse, respiration, and oxygen saturation) and pain to the baby by observing facial expression (eye squeezing, crying, and brow bulge). The heart rate, respiratory rate, and SpO2 (%) were compared before and immediately after the procedure using paired t-test. RESULT: Mean (±SD) gestational age and birth weight were 30.8±2.3 weeks and 1362.5±253.9 g, respectively. During examination in R- KMC position 8 babies (40%) were completely relaxed (no eye squeezing and crying), 10 (50%) were partially relaxed (no brow bulge) and 2 babies (10%) were not relaxed. A change in heart and respiration rate both by 10 per minute was recorded in 12 (60%) and 10 (50%) babies, respectively. Five babies (25%) had reduction in blood oxygen concentration below 92%. The majority of the mothers (19 of 20) were relaxed. CONCLUSION: ROP screening in R-KMC can be a baby friendly screening practice with respect to stress and pain to the infant and needs further evaluation in a larger cohort.

Primary tuberculosis of the tongue: a rare nodular presentation.

We report a case of a 38-year-old male who presented to us with a nodular swelling of the tongue with cervical lymphadenopathy suggestive of a malignancy. The lesion was diagnosed to be of tuberculous origin and the patient responded well to anti-tubercular chemotherapy.

Primary parotid tuberculosis: varied clinical presentations.

Parotid gland tuberculosis is rare and may present in different clinical forms. We present three cases of tuberculosis of the parotid gland that presented to us with different clinico-pathological appearances. The cases were diagnosed on the basis of histopathological evaluation and fine needle aspiration cytology. All the patients responded to four-drug antitubercular chemotherapy.

Primary tuberculous osteomyelitis of zygoma.

Osteomyelitis of zygomatic bone is rare, and tuberculous osteomyelitis is even rarer. This is the case report of a 3-year-old child presenting with a discharging sinus and swelling on the zygoma, which was initially thought to be orbital cellulitis. After further examination, she was diagnosed as having tuberculosis of zygoma and responded to anti-tubercular chemotherapy.

Pneumatization correlated to myringoplasty and tubal function.

The prognostic significance of the size of mastoid air cell system in the results of myringoplasty has been a matter of debate. Fifty ears with dry central perforation following C.S.O.M. were investigated. The size of mastoid air cell system was determined with planimetry of the X-ray picture and eustachian tube function was assessed using flourescein dye and nasal endoscopy. Myringoplasty was performed in all the 50 ears and postoperative results in terms of graft take up and hearing gain were assessed. The correlation between the size of mastoid air cell system, results of myringoplasty and tubal function has been discussed. The results show no correlation between the size of mastoid air cell system, postoperative results of myringoplasty and eustachian tube function.

Pseudotumor syndrome associated with antiphospholipid antibodies and cerebral venous sinus thrombosis.

Antiphospholipid antibodies have been recognized as a marker for an increased risk of thrombosis, including cerebral venous thrombosis. This is a clinical study of three patients who presented with features of raised intracranial tension. Investigations revealed normal CT of brain and CSF examination in two patients. MRI of brain revealed dural venous sinus thrombosis in all the patients and positive antiphospholipid antibodies in the blood. All patients recovered with anticoagulant therapy. Antiphospholipid antibodies should be considered in the differential diagnosis of pseudotumor syndrome related to cerebral venous thrombosis.

Neuroprotective agents in acute ischemic stroke.

The concept of neuroprotection relies on the principle that delayed neuronal injury occurs after ischemia. The phenomenon of the "ischemic cascade" has been described, and each step along this cascade provides a target for therapeutic intervention. A wide variety of drugs have been studied in humans. Ten classes of neuroprotective agents have reached phase III efficacy trials but have shown mixed results. They included calcium channel antagonists, NMDA receptor antagonists, lubeluzole, CDP-choline, the free radical scavenger tirilazad and ebselen, enlimomab, GABA agonist clomethiazole, the sodium channel antagonist fosphenytoin, magnesium, glycine site antagonist GV150526 and piracetam. Furthermore, the mechanisms that underlie the development of focal ischemic injury continue to be discovered, opening new therapeutic perspective for neuroprotection that might clinically be applicable in the future.

Current concepts in the management of acute ischemic stroke.

The treatment of stroke is multifaceted, and is governed by three, well established goals: 1) To minimize the extent of brain; 2) To medically support the stroke patient; and 3) To prevent further brain injury secondary to initial event or repeated vascular insults. Certain guidelines for emergency care, based on clinical experience and knowledge of pathophysiology, have been accepted in many institutions as the standard. This article provides guidelines about the current management of acute ischemic stroke based on currently available data from clinical trials. The target audiences for this article are emergency room physicians and neurologists, who manage the patients during the first few hours after stroke.

Chaperone-assisted overexpression of an active D-carbamoylase from Agrobacterium tumefaciens AM 10.

The N-carbamoyl-D-amino acid amidohydrolase (D-carbamoylase) gene (dcb) from Agrobacterium tumefaciens AM 10 was cloned by polymerase chain reaction in plasmid pET28a and was overexpressed in Escherichia coli JM109 (DE3). However, almost 80% of the enzyme remained trapped in inclusion bodies. To facilitate the expression of the properly folded active enzyme, the chaperones GroEL/ES were coexpressed in plasmid pKY206. This resulted in a 43-fold increase in active enzyme production compared to the wild-type strain. The histidyl-tagged D-carbamoylase was purified by a single step nickel-affinity chromatography to a specific activity of 9.5 U/mg protein.

Two-step purification of d(-)-specific carbamoylase from Agrobacterium tumefaciens AM 10.

A simple, economical and rapid affinity chromatography procedure with red dye as a ligand has been described for the two-step purification of a relatively thermostable d(-)-carbamoylase from the cell-free extract of Agrobacterium tumefaciens AM 10. The enzyme was purified 232-fold to homogeneity with a recovery of 30% in the presence of 2 mM dithiothreitol. The specific activity of the enzyme was 7.88 U/mg protein. The enzyme is a dimer with a native molecular mass of 67 kDa and a subunit relative molecular mass of 38 kDa. The isoelectric point of the enzyme was found to be 5.83. The K(m) values for N-carbamoyl-dl-methionine and N-carbamoyl-d-phenylglycine were 3.84 and 5.0 mM, respectively.

Ictal hemiparesis: differentiation from stroke.

This is a clinical analysis of four patients who presented with recurrent episodes of weakness on one side, feeling of heaviness, numbness, and inability to walk. Admission diagnosis was transient ischemic attacks in three patients and hemiplegic migraine in one patient. Attacks persisted for few minutes to few hours and were stereotyped for each patient and never became generalized during the course of the disease. Electroencephalography showed focal slowing and epileptiform discharges over parietal region. All patients responded dramatically to antiepileptic therapy. This is the first case report of ictal hemiparesis from this part of country.

Insulinoma presenting with dementia and hemiplegia.

A 23 year non-diabetic female presented with history of episodic alteration of sensorium, cognitive decline and right hemiparesis. Fasting blood glucose was found to be low on multiple occasions along with raised insulin levels. Abdominal CT scan and coeliac axis angiogram were normal. The diagnosis of insulinoma was confirmed on removal of the tumour on exploratory laprotomy. The patient was left with residual mild dementia and hemiparesis.